Artificial Intelligence (AI) has emerged as a valuable tool for assisting radiologists in breast cancer detection and diagnosis. However, the success of AI applications in this domain is restricted by the quantity and quality of available data, posing challenges due to limited and costly data annotation procedures that often lead to annotation shifts. This study simulates, analyses and mitigates annotation shifts in cancer classification in the breast mammography domain. First, a high-accuracy cancer risk prediction model is developed, which effectively distinguishes benign from malignant lesions. Next, model performance is used to quantify the impact of annotation shift. We uncover a substantial impact of annotation shift on multiclass classification performance particularly for malignant lesions. We thus propose a training data augmentation approach based on single-image generative models for the affected class, requiring as few as four in-domain annotations to considerably mitigate annotation shift, while also addressing dataset imbalance. Lastly, we further increase performance by proposing and validating an ensemble architecture based on multiple models trained under different data augmentation regimes. Our study offers key insights into annotation shift in deep learning breast cancer classification and explores the potential of single-image generative models to overcome domain shift challenges.

Deep learning models have shown great potential for image-based diagnosis assisting clinical decision making. At the same time, an increasing number of reports raise concerns about the potential risk that machine learning could amplify existing health disparities due to human biases that are embedded in the training data. It is of great importance to carefully investigate the extent to which biases may be reproduced or even amplified if we wish to build fair artificial intelligence systems. Seyyed-Kalantari et al. advance this conversation by analysing the performance of a disease classifier across population subgroups. They raise performance disparities related to underdiagnosis as a point of concern; we identify areas from this analysis which we believe deserve additional attention. Specifically, we wish to highlight some theoretical and practical difficulties associated with assessing model fairness through testing on data drawn from the same biased distribution as the training data, especially when the sources and amount of biases are unknown.